An ‘agreement’ between the junior doctors’ committee (JDC) of the British Medical Association (BMA) and the health secretary Jeremy Hunt has brought to a halt, for now, the doctors’ strikes that have been an ongoing thorn in the side of the government this year. But the show isn’t over until the BMA’s 45,000 junior members vote on the deal, the details of which have been shrouded in impenetrable briefings, leaks, and press releases from both sides, before finally being made public on 27 May. (See Junior doctors’ 2016 contract, NHS Employers website)

What is clear is that the ‘revised’ deal still represents a massive pay cut, with an abolition of pay banding for anti-social hours (already being fraudulently decreased through bureaucratic manoeuvres by cash-strapped hospital managements) and a relatively derisory increase in the rate of basic pay, which starts at £12 an hour for FY1 doctors, straight out of training, and increases over more than a decade of training to the princely sum of £22 per hour for the basic 40-hour week of the sub-consultant registrar training-grade doctors.

Considering the fact that today’s medical students can expect to accrue between £70,000 and £100,000 in debt during their six-year training, the servicing of which must be added to the ever-increasing costs of living, it is hardly an enticing offer.

Under the new ‘agreed’ contract, doctors working in hospitals at night will work for virtually the same pay rates as during normal daylight hours, with a slight increase in rates (from £12 to £16 for FY1 grades, for example – just enough to keep them in coffee to try and stay awake!) between the hours of 9.00pm and 7.00am. The previously disputed Saturdays, and now also Sundays, will be treated like any other working day.

Doctors on call from home will be ‘granted’ a minor annual allowance, rather than being paid for the hours they spend covering the service. It should be noted that being ‘on call from home’ very often means being in the hospital all night and providing emergency care, including performing emergency operations, in addition to working full days before and afterward.

All other minor ‘concessions’ on the part of the government pale into insignificance beside this main capitulation of the BMA negotiating committee. All of which begs the question: what exactly transpired to make the leadership agree to such a deal?

The dispute so far

England’s 55,000 junior doctors have taken industrial action on eight days since January as part of a campaign of protest against new terms and conditions that the government had threatened to impose upon them.

Following the spirited and much publicised 9.00am-5.00pm full walk-out on 26 and 27 April, in which junior doctors withdrew cover from both elective and emergency services for two consecutive weekdays, an abrupt halt to the stand-off between the BMA’s Junior Doctors Committee (JDC) and Health Secretary Jeremy Hunt – a five-day ‘pause’ in imposition, in face-saving PR parlance – was announced at the beginning of May.

The government, despite all its negative spin – claiming this dispute was about greedy doctors standing in the way of its altruistic desire to improve the NHS by providing weekend services and decreasing alleged ‘excess’ mortality – failed entirely in its goal of isolating the junior doctors from the broad public support they continue to enjoy.

The junior doctors, for their part, should be congratulated on creating a vibrant, grassroots movement that put these messages clearly:

- That there is no real excess in weekend mortality. (See Inaccurate coding of patient data may explain ‘weekend effect’, BMJ press release, 16 May 2016)

- That PR spin and ‘pseudo-scientific’ evidence was being used by Hunt and the government to drive unnecessary changes that would worsen services. (See The ‘weekend effect’ in hospitals may NOT exist: expert claims figures are skewed because admissions aren’t recorded correctly by Madlen Davies, Mail Online, 9 May 2016)

- That spreading existing insufficient resources more thinly would not improve, but wreck the NHS. (See David Cameron – what’s your plan for seven-day NHS services?, BMA, 24 May 2016)

- That the contract Hunt sought to impose was about decreasing pay (for junior doctors first, but ultimately for all medical and NHS staff), cheapening services, increasing working hours and, in the process, penalising doctors who went part time, undertook research, or took time out of their careers – especially women having children. (Junior doctors outraged over new contract that ‘discriminates against single women’ by Charlie Cooper, Independent, 1 April 2016)

The goal? Increasingly, the junior doctors have come to the conclusion that the government’s goal is to privatise the NHS, and their array of placards, articles, interviews and quotes made that perfectly clear. (See The health crisis is about more than junior doctors on strike. We need a public movement to save our NHS by Youssef El Gingihy, Independent, 24 April 2016)

They are to be congratulated for expanding their basic slogan of ‘Not fair, not safe’ to the much more far-reaching ‘Save our NHS!’, which gets right to the heart of the matter and educates the wider public about what’s really at stake. (See The connection between the junior doctors’ contract and the US corporate takeover of the NHS by Bob Gill, Proletarian, December 2015)

While the doctors’ dispute has acted as a nucleus around which a broader anti-austerity movement has started to coalesce, this movement itself is hampered by the usual constraints that go with our current stultifying political environment. In particular, a narrow, Labour party-centred (People’s Assembly, Counterfire, SWP Trots and revisionists), social-democratic outlook that sees the ‘bigger picture’ as being merely the downfall of Hunt, or maybe of the entire Tory government and the installation of Jeremy Corbyn as the great saviour – not only of the NHS, but of British workers in general.

Alongside this, the strike movement was developing a growing realisation that the only way to safeguard the NHS and public services from the government hatchet-men was to appeal directly to the general public – to the working people who so dearly value and rely upon their services – rather than to the very politicians (Tory, LibDem or Labour) who have made their careers from serving the business interests of monopoly capital that are the driving force behind NHS privatisation.

While, on the whole, the ability of the junior doctors to concentrate on the matter at hand – resisting the imposition of what amounts to a hefty pay cut, and linking this to the defence of the NHS as a public provider of healthcare – has been a breath of fresh air, we must recognise that the dominant perspective of the leadership of the BMA JDC is far less inclined to make ‘political’ points about the privatisation of the NHS. These leaders are instead keen to keep all talk and action firmly within the bounds of a narrow contractual negotiation.

Thus, negotiations between the JDC and Hunt took place between 9 and 13 May, with Hunt insisting that no concessions were on the table, yet leading to the announcement on 18 May that the JDC had accepted a ‘revised’ contract and would recommend it to their membership, subject to a postal ballot that is scheduled to take place between 17 June and 1 July, with the result due by 6 July.

Capitulation of BMA JDC leadership, amidst government jubilation

Evaluating the outcome of negotiations has been difficult, for while Hunt openly declared victory, stating in parliament that the new, ‘modernised’ contract met “all the red lines of the government for delivering a seven-day NHS” and “remains within the existing pay envelope” (ie, that extension of hours would not cost any more wages, and that he had achieved the hefty pay cut he set out to impose), the JDC failed to make clear what terms it had agreed to, merely promising to produce future lengthy explanatory documents.

Having formerly decried the BMA for not acting like a union, we now find the JDC are quick studies, for in classic capitulatory trade-union leadership fashion (is there a manual?), JDC chair Johann Malawana has been platitudinously assuring BMA members that this was “absolutely the best deal possible”.

The national press were quick to seize upon several key capitulations. Namely, that:

- Saturdays and Sundays will count as “plain time” – part of a junior doctor’s normal working week. This is a big U-turn by the BMA, which has until now consistently refused to countenance any of Saturday being classified in that way.

- Hunt was able to hail the BMA’s change of tack as helping him to bring in the “truly seven-day NHS” that the Conservatives have pledged. The new system makes it one third cheaper for hospitals to roster junior doctors to work at weekends, he says.

- The new deal does not offer anything concrete to help junior doctors overcome the difficulty of arranging childcare for the extra weekend shifts many will be working – another problem identified by the equality assessment back in March. (See Junior doctors’ contract deal: what was agreed by Denis Campbell, The Guardian, 18 May 2016)

This capitulation has clearly caused anger among junior doctors, who agonised over their duty as doctors, but supported strike action, lost pay in carrying it out, and remain committed to the cause both of winning the dispute and safeguarding the working lives of junior doctors now and in the future, and of protecting the NHS for future generations.

Malawana’s response to just criticism has been to condemn “people that are trying to hijack the legitimate concerns of a group of employees and use that groundswell to prove political points. The vast majority of doctors I have talked to, though, don’t want to have this dispute hijacked for political reasons and want the focus to be on getting the best deal for members.” (Quoted in Junior doctors’ leader urges trainee medics to stop ‘scaremongering’ by Denis Campbell and Sarah Johnson, The Guardian, 26 May 2016)

Johann’s words could very well have issued from the government’s disinformation (sorry, press) releases on the junior doctors’ strikes with which we were being bombarded just a few short weeks ago.

The BMA hopes to persuade junior doctors to endorse the deal through a long document that explains what its terms and conditions will mean, but no amount of lengthy explanation is likely to weigh more in the decision-making of frontline staff than the bullet points noted above. The BMA will now spend its members’ money on undertaking a series of roadshows around England to try and boost the chances of a ‘yes’ vote – while demonising doctors that have already begun to speak out against the ‘new deal’.

Laura Lefley, a GP in Brighton, wrote on the JDC Facebook forum: “I’ve looked at [the new contract]. I’m a GP, but if I was still in training I wouldn’t sign it. It’s crap for women. How can they provide extra funds for us to catch up with training after maternity leave?? We can’t work any faster. We don’t want extra funding for training, we want equal pay.”

It is clear that the contract ‘agreed’ between the BMA leadership and the government represents a defeat for the medical profession, the NHS and the wider British public. We urge our readers to examine it, understand its true significance – and oppose it.

Vote No to the ‘new contract’!

Postscript

An interesting footnote to the negotiations process has come to light through the leaking of JDC leaders’ WhatsApp group messages during the whole strike period, as reported in the healthcare management journal HSJ and taken up by the mainstream press. (Huge leak reveals BMA plan to ‘draw out’ junior doctors dispute by Shaun Lintern, HSJ, 26 May 2016)

The leak is largely quite banal, but does show that at the end of April, following the full walkout strike and with the government still proposing to press ahead with contract imposition, the nerve of the JDC negotiating team began to waver, with Johann Malawana asking his fellow negotiators whether the BMA should “put everything back on the table” – a reference to the possibility of agreeing to talk about all issues that had previously been put off-limits, including Saturday pay.

Clearly succumbing to the pressure from government and ‘senior’ doctors (rather than sticking to the remit his members had given him), he told the group: “Ok so if Hunt is simply not going to back down because he sees this as a chance to make a leadership bid by breaking a trade union, is our current aim of lifting imposition by a full front on attack the right one? Or should we trying something slightly different? Offer to talk about anything he wants as long as imposition is lifted and the end result is a contract that is not discriminatory and unsafe.

“Put everything back on the table. As it were.”

The first discussions in the group about conceding the issue of plain-time Saturday pay took place at the start of May. No consultation was made with members in advance of this step. It followed a call by the medical colleges for further talks, and the government stating it would take part and suspend the process of contract imposition – just so long as Saturday pay was part of discussions.

On 5 May, ahead of a meeting of the full JDC to decide next steps, Conan Castles told the WhatsApp group: “Given that I was the only vote at the last JDC meeting to say that we should consider compromise on our position, I feel it’s worth being aware ... we need to be careful that we don’t look like we are being ridiculous by going back on our vote [on negotiating Saturday pay] so notably.

“I still feel we should do it, I feel we should have done it a while ago, but please do be aware that JDC will look a bit confused if they change their minds so much in such a short period of time. ” (Our emphasis)

On 6 May, the executive decided on the WhatsApp group to adopt a ‘cabinet responsibility’ approach to its discussions with the full JDC, meaning they would all be required to support the executive’s positions in the meeting, even if they disagreed (a standard bureaucratic manoeuvre for railroading policy through a committee with minimal real discussion).

At the full JDC meeting the next day it was thus decided to re-enter talks, now with the inclusion of Saturday pay. These talks ultimately led to the deal announced on 18 May, which included plain time across the weekend.

However, also on 7 May, the WhatsApp messages reveal, two members of the executive resigned, on what another member of the group described as a “difficult” day. The two members who resigned were Dr Castles and Charlotte Elliot.

And in this way, the principled position and struggle of the mass of junior doctors to defend their profession, their patients, and the future of the NHS was bartered away. It is clear that more than the senior leadership of the BMA needs sweeping away, if the doctors are to carry their dispute to a successful conclusion.

The real character of an individual is revealed when the struggle intensifies. Johann Malawana has made veiled threats to resign if junior doctors vote against his capitulatory agreement. All things considered, his departure should be welcomed, along with his replacement by someone more suited to the task at hand.